Perforation of appendiceal diverticulum causing local peritonitis: a case report and literature review

Diverticulosis of the appendix is a rare pathological entity and there is association with the presence of neoplasms. Peritonitis caused by ruptured appendiceal diverticulum, as a result of inflammation, is an even rarer medical condition. The inflammation of appendiceal diverticula should be part of the differential diagnosis of right iliac fossa pain, especially in patients with signs of acute appendicitis, and computed tomography of the abdomen is the most useful imaging modality. An early accurate diagnosis is difficult and surgical approach remains the treatment of choice.

A 53-year-old male patient presented to Accident and Emergency Department due to lower abdominal pain, vomiting and fever. Primary evaluation and laboratory tests were suggested for intra-abdominal infection. A computed tomography confirmed the presence of right iliac fossa inflammation associated with a small fluid collection due to perforated appendix. The patient underwent an urgent laparoscopic appendicectomy and his post-operative period was uneventful. The pathologic examination identified a ruptured appendiceal diverticulum associated with abscess formation in the mesoappendix.

It is of utmost importance for clinicians and radiologists to be aware of this rare clinical condition due to its potentially serious complications related to it. Any delay in the management may lead to increased risk of morbidity and mortality. Further research is needed to improve the diagnostic accuracy and to ameliorate the patients' treatment options.